CMS Tribal LTSS Program Survey

CMS Tribal Long Term Services and Supports (LTSS) Program Survey

CMS LTSS Survey_Final Follow-up Fax_Attachment K_508_Revised

CMS Tribal LTSS Program Survey

OMB: 0938-1350

Document [pdf]
Download: pdf | pdf
Final Follow-up Fax
Dear (insert name):
Thank you for taking the time to speak with KAI staff on the phone about the CMS Tribal LTSS Program.
As requested, I have sent a paper version of the survey.
Please complete the survey and return it via fax to (insert fax number).
If you have any questions, please contact me at (insert phone number).
I want to thank you for your willingness to participate in this important survey. With your help, the CMS
Tribal LTSS Survey will encourage collaboration and sharing of LTSS best practices in Indian Country and
contribute to tribal LTSS research efforts.
Many Thanks,

(insert KAI staff name that made phone call)

ID No: CMS-10651 | PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0938-New (Expires: TBD). The time required to complete this information collection is estimated to average 15
minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05,
Baltimore, Maryland 21244-1850.


File Typeapplication/pdf
File TitleCMS LTSS Survey Final Follow-Up Fax Attachment K
SubjectCMS, Centers for Medicare and Medicaid Services, LTSS, Long-term Services and Support, Tribal, Survey, Follow-up Email Document,
AuthorCenters for Medicare and Medicaid Services
File Modified2017-06-16
File Created2017-02-14

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